Association of Diabetes-related Emotional Distress with Diabetes Self-care and Glycemic Control among Adult Patients with Type 2 Diabetes at a Tertiary Hospital in Manila, Philippines
Objective. The study aims to determine the association of diabetes-related emotional distress with reported diabetes selfcare, and glycemic control of adult Filipinos with type 2 diabetes mellitus at The Medical City using 2 psychometric tests.
Methodology. This is a cross-sectional study conducted among 94 Filipinos diagnosed with type 2 diabetes mellitus, who answered 2 validated English questionnaires: Problem areas in diabetes (PAID-20) and Diabetes self-management questionnaire (DSMQ) that screen for diabetes-related emotional distress and diabetes reported self-care, respectively. Data were encoded and analyzed using Stata SE v.13.
Results. 42.6% of Filipinos with type 2 diabetes mellitus had emotional distress showing moderate to severe distress in factor 1 (diabetes-related emotional distress) and factor 3 (food related problems). 51.1% had suboptimal self-care, poorly scoring in areas of health-care use and dietary control. Majority of those who had diabetes-related distress and poor self-care where young, pre-obese and had diabetes duration of ±5 years. There was no significant association between diabetes-related emotional distress with diabetes self-care and emotional distress with glycated hemoglobin, but majority of those who had diabetes distress had higher glycated hemoglobin. There was significant association between diabetes self-care and glycemic outcomes (p=0.006) with relative risk of 1.51 (95% CI 1.10-2.07). There was linear inverse weak correlation between all subdomains of DSMQ with glycated hemoglobin except Dietary Control.
Conclusion. Diabetes-related emotional distress and sub-optimal self-care are prevalent among Filipinos with type 2 diabetes mellitus. Those who had poor self-care were 1.5 times more likely to have poor glycemic outcomes.
World Health Organization. Global report on diabetes, 2016. https://www.who.int/diabetes/global-report/en/.
UNITE for Diabetes Philippines. Compendium of Philippine Medicine, 2013. http://endo-society.org.ph/wp-content/uploads/ 2013/06/Diabetes-United-for-Diabetes-Phil.pdf.
American Diabetes Association. Standards of medical care in diabetes 2017;40(Suppl 1):s48-s56; s57-s8. https://professional.diabetes.org/files/media/dc_40_s1_final.pdf.
Welch GW, Johnson AM, Polonsky WH. The problem areas in Diabetes Scale: An evaluation of its clinical utility. Diabetes Care. 1997;20(5):760-6. https://www.ncbi.nlm.nih.gov/pubmed/9135939. https://doi.org/10.2337/diacare.20.5.760.
Chew BH, Shariff-Ghazali S, Fernandez A. Psychological aspect of diabetes care: Effecting behavioral change in patients. World J Diabetes. 2014;5(1);796-808. https://www.ncbi.nlm.nih.gov/pubmed/25512782. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265866. https://doi.org/10.4239/wjd.v5.i6.796.
Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care. 2012;35(2):259-64. PMID: 22228744.PMCID: PMC3263871. https://doi.org/10.2337/dc11-1572.
Fisher L, Mullan J, Skaff MM, Glasgow RE, Arean P, Hessler D. Predicting diabetes distress in patients with type 2 diabetes: A longitudinal study.Diabet Med. 2009;26(6):622-7. https://www.ncbi.nlm.nih.gov/pubmed/19538238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740749. https://doi.org/10.1111/j.1464-5491.2009.02730.x.
Polonsky WH, Anderson BJ, Loher PA, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18(6);754-60. https://www.ncbi.nlm.nih.gov/pubmed/7555499. https://doi.org/10.2337/diacare.18.6.754.
Lee J, Lee EH, Kim CJ, Moon SH. Diabetes-related emotional distress instruments: A systemic review of measurement properties.International journal of nursing studies. 2015;52(12); 1868-78. https://www.ncbi.nlm.nih.gov/pubmed/26271434. https://doi.org/10.1016/j.ijnurstu.2015.07.004.
Alberti G. The DAWN (diabetes, attitudes, wishes and needs) study.Pract Diabetes Int. 2002;19(1); 22-4.
Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): Development and evaluation of an instrument to assess diabetes self-care activities associated with glycemic control. Health Qual Life Outcomes.2013;11:138. https://www.ncbi.nlm.nih.gov/pubmed/23937988. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751743. https://doi.org/10.1186/1477-7525-11-138.
Schmitt A, Reimer A, Hermanns N, et al. Assessing diabetes self-management with the Diabetes Self-Management Questionnaire (DSMQ) can help analyze behavioural problems related to reduced glycemic controls. PloS One. 2016;11(3): e0150774. https://www.ncbi.nlm.nih.gov/pubmed/26938980. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777391. https://doi.org/10.1371/journal.pone.0150774.
Snoek FJ, Pouwer F, Welch GW, Polonsky WH. Diabetes-related emotional distress in Dutch and U.S. diabetic patients: Crosscultural validity of the problem areas in diabetes scale. Diabetes Care. 2000;23(9):1305-9. PMID: 10977023. https://doi.org/10.2337/diacare.23.9.1305.
Miller ST, Elasy TA. Psychosomatic evaluation of the Problem Areas in Diabetes (PAID) survey in Southern, rural African American women with Type 2 diabetes. BMC Public Health. 2008;8:70. https://www.ncbi.nlm.nih.gov/pubmed/18294380. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2268930. https://doi.org/ 10.1186/1471-2458-8-70.
Lee EH, Lee YW, Lee KW, Kim YS, Nam MS. Measurement of diabetes-related distress using the Problem Areas in Diabetes scale:Psychometric evaluations show that the short form is better than the full form. Health Qual Life Outcomes. 2014;12:142. https://www.ncbi.nlm.nih.gov/pubmed/25358396. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215007. https://doi.org/10.1186/s12955-014-0142-z.
Snoek FJ, Kersch NYA, Eldrup E, et al. Monitoring of Individual Needs in Diabetes (MIND)-2. Diabetes Care. 2012;35(11):2128-32. https://www.ncbi.nlm.nih.gov/pubmed/22837364. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476905. https://doi.org/10.2337/dc11-1326.
Schmitt A. Diabetes Self-Management Questionnaire (DSMQ), 2013. https://eprovide.mapitrust.org/instruments/diabetes-selfmanagement-questionnaire.
Nicolucci A, Kovacs Burns K, et al. Diabetes attitudes, wishes and needs second study (DAWN2TM): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med.2013;30(7):767-77. https://www.ncbi.nlm.nih.gov/pubmed/23711019. https://doi.org/10.1111/dme.12245.
Skovlund S, Peyrot M. The diabetes attitudes, wishes and needs (DAWN) program: A new approach to improving outcomes of diabetes care. Diabetes Spectrum.2005;18(3): 136-42. https://doi.org/10.2337/diaspect.18.3.136.
Jimeno CA, Sobrepeña LM, Mirasol RC. DiabCare 2008: A survey on glycemic control and the status of diabetes care and complications among patients with type 2 diabetes mellitus in the Philippines. Philipp J Int Med. 2012;50(1):15-22.
Stranderg RB, Graue M, Wentzel-Larsen T, Peyrot M, Rokne B. Relationship of diabetes-specific emotional distress, anxiety, and overall well-being with HbA1C in adult with type 1 diabetes. J Psychosom Res. 2014;77(3):174-9. https://www.ncbi.nlm.nih.gov/pubmed/25149027. https://doi.org/10.1016/j.jpsychores.2014.06.015.
Strandberg RB, Graue M, Wentzel-Larsen T, Peyrot M, Thordarson HB, Rokne B. Longitudinal relationship between diabetes-specific emotional distress and follow-up HbA1c in adults with type 1 diabetes mellitus. Diabet Med. 2015;32(10):1304-10. https://www.ncbi.nlm.nih.gov/pubmed/25865313. https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC4676291. https://doi.org/ 10.1111/dme.12781.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study Group (UKPDS) Group. Lancet. 1998;352(9131):837-53. https://www.ncbi.nlm.nih.gov/pubmed/9742976.
Ogbera A, Adeyemi-Doro A. Emotional distress is associated with poor self care in type 2 diabetes mellitus. J Diabetes. 2011;3(4):348-52. https://www.ncbi.nlm.nih.gov/pubmed/21883978. https://doi.org/10.1111/j.1753-0407.2011.00156.x.
Mehravar F, Mansournia MA, Holakouie-Naieni K, Nasli-Esfahani E, Mansournia N, Almasi-Hashiani A. Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. Epidemiol Health. 2016;38:e2016004. PMID: 26883737. PMCID: PMC4789607. https://doi.org/10.4178/epih/e2016004.
Bukhsh A, Lee SWH, Pusparajah P, Schmitt A, Khan TM. Psychometric properties of the Diabetes Self-Management Questionnaire (DMSQ) in Urdu. Health Qual Life Outcomes. 2017;15(1):200. https://www.ncbi.nlm.nih.gov/pubmed/29025432. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639758. https://doi.org/10.1186/s12955-017-0776-8.
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